Digital Commons Network^™

Multi-Symptom Management In Hospice Patients During End-Of-Life Transition, Ashley N. B. Sirianni

Theses and Dissertations

The purpose of this quality improvement project is to compare the provider’s perception following an educational model of using single symptom management versus multi-symptom management during the end-of-life transition in adult patients for improved quality of life outcomes. The appraised evidence indicates that it is critical to have anticipatory medications at the patient’s residence to manage multiple symptoms rather than focusing exclusively on a single symptom management such as pain management. In February 2016, the author conducted an educational model among hospice providers for increasing knowledge and awareness of multi-symptom management. Thirty (n = 30) Clinical Nursing Directors, Licensed Practical …

Factors That Influence Advance Directives Completion Amongst Terminally Ill Patients At Akuhn, Stephen Omondi Otieno

Master of Medicine in Internal Medicine

Background: An advance directive is a written or verbal document that legally stipulates a person’s health care preference while they are competent to make decisions for themselves, and which is then used to guide decisions on life-sustaining treatment in the event that they become incapacitated. Advance directives can take one of four forms: a living will, a limitation of care document, a do-not-resuscitate order, and an appointment of a surrogate by durable power of attorney. The completion rate of advance directives varies from region to region, and it is influenced by different patient, caregiver, legal, institutional, cultural, and religious factors. …

Describing The End Of Life Knowledge, Beliefs, And Preferences Of Alaska Native And American Indian Peoples, Colleen Marie Kelley

Theses and Dissertations

This dissertation is comprised of three manuscripts that will be submitted for publication, describing the end of life knowledge, beliefs, and preferences of Alaska Native and American Indian Peoples. The first manuscript is a literature review that examines what is known about the understanding about the end of life knowledge, beliefs, and preferences of Alaska Native and American Indian Peoples. The second manuscript offers results of an exploratory descriptive study designed to describe the end of life knowledge of hospice care services, beliefs about dying, and preferences for end of life care of Alaska Native and American Indian Peoples. Finally, …

Rekindling The Passion For Nursing, Susan M. Cannon

Nursing Theses and Capstone Projects

Nurses often experience compassion fatigue and burnout when working in stressful environments. Nurses tend to put the needs of their patients above their own needs. It is imperative for the work environment to promote relaxation and restoration, to avert compassion fatigue and nursing burnout. All employees of the project director’s organization were encouraged to attend Caring for the Caregiver Day, a hospital-sponsored event which provided education and promoted self-help interventions aimed to decrease compassion fatigue and burnout. The event included aromatherapy, music therapy, art therapy, pet therapy, massage therapy, and education on compassion fatigue for nurses. In addition, the Progressive …

Impact Of Nursing Interventions On Positive Confusion Assessment Method (Cam) Scores, Katie Halsell

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Delirium occurs in patients of all ages, especially in the older adult population. Symptoms vary from patient to patient, and delirium is often misdiagnosed. Patients with delirium have a higher cost of care and a longer length of stay in the hospital. Delirium is a stressful event for both the nurse and the patient, resulting in poor patient outcomes. The Confusion Assessment Method (CAM) tool is used to diagnose delirium in confused patients; a positive CAM score indicates delirium. Nursing interventions are used to treat delirium. Interventions used range from non-pharmacologic measures to use of pharmacological measures and restraints. This …

Helping Nurses Cope With Patient Death: Coping Resource Bundle, Brittany Esgro Bsn, Rn, Amy Gust Bsn, Rn, Kate Saunders Bsn, Rn, Courtney Yankelitis Bsn, Rn

Patient Care Services / Nursing

Esgro, B., Gust, A., Saunders, K., Yankelitis, C. (2016, March 14-17). Helping Nurses Cope with Patient Death. Poster presented at: Annual Nurse Residency Program Meeting, Bonita Springs, FL.

Esgro, B., Gust, A., Saunders, K., Yankelitis, C. (2016, 2015, September 10). Helping Nurses Cope with Patient Death. Philadelphia Area Magnet Meeting.

Esgro, B., Gust, A., Saunders, K., Yankelitis, C. (2016, March 14). Helping Nurses Cope with Patient Death: Coping Resource Bundle. Poster presented at: UHC/AACN Nurse Residency Program™ 2016 Annual Meeting & Chief Nursing Officers Council Meeting, Bonita Springs, FL.

Esgro, B., Gust, A., Saunders, K., Yankelitis, C. (2016, October 28). …

2016-2017 Pediatric Subspecialty Trainees And Residents, Children's Mercy Hospital

Residents and Fellows Portraits

Photo composites of the graduate pediatric trainees in allergy/immunology, child abuse pediatrics, child neurology, clinical child psychology, clinical cytogenetics & molecular genetics, clinical pharmacology, developmental-behavioral pediatrics, hospice Y palliative care, neonatal-perinatal medicine, pediatric cardiology, pediatric critical care medicine, pediatric dentistry, pediatric endocrinology, pediatric emergency medicine, pediatric ethics, child gastroenterology, pediatric hematology/oncology, pediatric hospital medicine, pediatric infectious diseases, pediatric nephrology, pediatric optometry, pediatric otolaryngology, pediatric plastic surgery, pediatric pulmonology, pediatric radiology, pediatric rehabilitation, pediatric sports medicine, pediatric surgery, pediatric residency and med/peds residency

Nurses' Knowledge Of Advance Directives And Perceived Confidence In End-Of-Life Care: A Cross-Sectional Study In Five Countries, A. Coffey, G. Mccarthy, E. Weathers, M. I. Friedman, K. Gallo, M. Ehrenfeld, S. Chan, W. H.C. Li, P. Poletti, M. Itzhaki, +4 Additional Authors

Journal Articles

No abstract provided.

Hospice Performance: Environmental And Organizational Correlates, Mengying He

All ETDs from UAB

The purpose of this dissertation is to explore hospice performance using a three paper format. Based on Structure-Conduct-Performance (SCP) and Structure-Process-Outcome (SPO) models, paper 1 conducts a systematic literature review to identify gaps in hospice performance research. Paper 2 explores the relationship between hospice market structure and inpatient services provision (Structure-Conduct). Market munificence is related to hospice inpatient services offering. Organizational factors such as hospice chain-affiliation, age, and ownership also play roles in predicting hospices’ probability in providing inpatient services. Paper 3 examines the impact of hospice inpatient service provision on service utilization and financial performance (Structure-Process-Outcome). Hospices that not …

Examining Nurse Practitioners' Perceptions And Beliefs Regarding Hospice Referrals For African Americans, Karen Jackson Mcclary

Walden Dissertations and Doctoral Studies

Terminally ill patients often have difficult choices at the end-of-life, and electing to receive hospice services is one of them. Hospice has been linked to improved quality of life and death and is accessible to terminally ill patients. Despite the accessibility, African American patients often make the decision to forgo hospice services. The purpose of this descriptive study was to explore perceptions and beliefs of nurse practitioners (NPs) regarding the lack of utilization of hospice for African American patients and the feasibility of NPs for initial referral for terminally ill African American patients. The research questions addressed whether an NP's …

An Educational Initiative To Prevent Unnecessary Hospitalization For Hospice Patients, Alkeisha Hill Mims

Walden Dissertations and Doctoral Studies

Avoidable hospitalizations of hospice patients cost Medicare $3 billion a year. When hospice nurses are able to identify early signs and symptoms of acute illness and provide appropriate interventions to prevent such admissions, 20-60% of the hospitalizations are preventable. The practice problem addressed in this quality improvement doctor of nursing project was the 30% hospital admission rate of hospice patients as evidenced by chart review, admission data, and revocation data. The first purpose of the project was to identify evidence-based nursing care paths in the literature for the top 5 medical diagnoses related to avoidable hospital admissions. The second purpose …

I'M Still Standing, But I'M Not Standing Still, Janice E. Hawkins

Ellmer School of Nursing Faculty Publications

(First paragraph) When I made the decision to return to school for a PhD, I anticipated hard work, challenges, and a demanding schedule. Two years into my part-time program, I proudly informed readers of Reflections on Nursing Leadership that I was still standing and happy with my decision (Hawkins, 2014). Two years later, I'm not quite done.

Comparing The Quality Of End Of Life Cancer Care In The Medicare Population Prior To And After The Enactment Of The Medicare Prescription Drug, Improvement And Modernization Act Of 2003, Rene Jooste

All ETDs from UAB

Reimbursement for chemotherapy could account for two thirds of the income for oncologists in private practice. The Medicare prescription drug improvement and modernization act of 2003 (MMA) brought about a dramatic change in the way physicians were reimbursed for delivering chemotherapy in an attempt to slow the skyrocketing costs of drugs and Medicare costs for covering these drugs . The MMA reduced Medicare reimbursements for covered outpatient prescription drugs from 95% to 85% of the average wholesale price. In 2005, a new payment system was instituted that reimbursed fee-for-service providers for drugs at the national average sales price plus 6%. …

Moral Distress And The Health Care Organization, Andy Kondrat

Dissertations

A health care professional may experience moral distress when she believes she knows the ethical course of action in a given situation, but is unable to enact that plan, or must do otherwise. This dissertation argues that health care organizations have an ethical obligation to address moral distress in their health care professionals, and that common responses to moral distress are ethically insufficient due to their reliance on hierarchical solutions when hierarchies are, in fact, often a cause of moral distress. Thus, health care organizations, as moral agents, have a responsibility to find a non-hierarchical response to moral distress.

In …

Provision Of Hospital-Based Palliative Care And The Impact On Organizational And Patient Outcomes, Marisa L. Roczen

Theses and Dissertations

Hospital-based palliative care services aim to streamline medical care for patients with chronic and potentially life-limiting illnesses by focusing on individual patient needs, efficient use of hospital resources, and providing guidance for patients, patients’ families and clinical providers toward making optimal decisions concerning a patient’s care. This study examined the nature of palliative care provision in U.S. hospitals and its impact on selected organizational and patient outcomes, including hospital costs, length of stay, in-hospital mortality, and transfer to hospice. Hospital costs and length of stay are viewed as important economic indicators. Specifically, lower hospital costs may increase a hospital’s profit …

Development Of A Program Proposal For A Nitrous Oxide Program In Pediatrics, Sarah Oleson

Walden Dissertations and Doctoral Studies

When pediatric patients are admitted to the inpatient or outpatient hospital setting they potentially have to endure procedures that cause pain, fear, and anxiety which can have a lifelong impact on the child's response to future healthcare needs. The purpose of this project was to create a comprehensive program proposal for a nitrous oxide sedation program to minimize those perceptions towards medical procedures. The project utilized a systematic review of literature and secondary data to address the most important indicators for developing a comprehensive program proposal to present to the pediatric leadership team. Multiple studies have shown nitrous oxide having …

Rehabilitation And Cancer Survivorship, Matthew Denning, Samantha Fisk, Alyssa Grigware, Mary Leopold, Erika Lopez, Margaret Masiak, Sebastian Stoltzfus, Ashley Tomaswick

Disease Prevention and Health Promotion Resources

Presentation given at Central Maine Medical Center on December 4, 2015, to build awareness of the role of rehabilitation services in cancer survivor management and discuss strategies to address existing needs. This presentation was based on a project undertaken to determine which physical distress screening tools are most appropriate to trigger a wellness or rehabilitation referral when it is warranted for a survivor. The use of effective screening tools will assist in directing cancer survivors, who experience physical and emotional burdens caused by the disease and subsequent treatment, to access services that will continue to improve their overall quality of …

Helping Nurses Cope With Patient Death, Courtney Yankelitis Bsn, Rn, Brittany Esgro Bsn, Rn, Kate Saunders Bsn, Rn, Amy Gust Bsn, Rn

Patient Care Services / Nursing

No abstract provided.

Ketamine For The Treatment Of Depression In Patients Receiving Hospice Care: A Retrospective Medical Record Review Of Thirty-One Cases., Alana Iglewicz, Katherine Morrison, Richard A. Nelesen, Tingting Zhan, Boris Iglewicz, Nathan Fairman, Jeremy M. Hirst, Scott A. Irwin

Department of Pharmacology and Experimental Therapeutics Faculty Papers

BACKGROUND: Depression is prevalent in patients receiving hospice care. Standard antidepressant medications do not work rapidly enough in this setting. Evidence suggests that ketamine rapidly treats treatment refractory depression in the general population. Ketamine׳s role for treating depression in the hospice population warrants further study.

METHODS: A retrospective medical record review of 31 inpatients receiving hospice care who received ketamine for depression on a clinical basis was conducted. The primary outcome measure was the Clinical Global Impression Scale, which was used retrospectively to rate subjects׳ therapeutic improvement, global improvement, and side effects from ketamine over 21 days. Additionally, time to …

Hospice Care In Malaysia: Knowledge, Attitude And Time Of Discussion, Shanthi Ellen Solomon

Loma Linda University Electronic Theses, Dissertations & Projects

Despite available and adequate hospice care resources, fewer terminally ill patients in Malaysia use hospice care services than one might reasonably expect. It is reported that only around 10% of patients who die of terminal illness in Malaysia, die in hospice care (Devaraj, 2003). The projected number of individuals that should receive palliative care in Malaysia is 17 to 27% (Connor & Sepulveda Bermedo, 2014). In order to study why hospice care is not accessed as expected, nurses and doctors in Penang and Sabah completed a survey measuring knowledge of current hospice practices, attitude toward caring for the dying, personal …

Analyzing Pain Medication Use And Adherence In Patients With Myotonic Dystrophy And Facioscapulohumeral Dystrophy, Bryan Fitzgerald, Amy L. Parkhill

Pharmacy Faculty/Staff Publications

Objectives: Myotonic dystrophy (DM) and facioscapulohumeral dystrophy (FSHD) are two of the most common muscular dystrophies in adults. It has been reported that patients with these two disorders may suffer from pain and inadequate pain management. The purpose of this study is to analyze the current use of pain medications and develop a survey to assess pain medication use and adherence in this patient population.

Methods: Patients registered in the National Registry for DM and FSHD at the University of Rochester were surveyed on pain medication use and the most significant problem of their disease. After analysis of these surveys, …

Impact Of Hospice Nurse Education On After-Hours Calls And Visits, Cheryl Slack

Evidence-Based Practice Project Reports

Medicare-certified hospice home care agencies must provide a 24/7 on call system for after business hours patient concerns. An agency identified a problem with a high volume of after-hours hospice calls for symptom management. How these calls are handled impact patient and family outcomes and satisfaction. A literature review provided evidence that hospice nurse education and appropriate telephone support improves symptom management, enhances family support, provides a sense of security, reduces anxiety, and promotes comfort. Providing hospice nurse education on symptom management supported the goal of this evidence based practice (EBP) project to reduce the family/caregiver need for frequent on-call …

Choices Related To Maximizing Quality Of Life At End Of Life, Theresa Lynn

Dissertations

Humans, including those residing in the United States, can live in denial of their own mortality. Because of this, futile care is sometimes provided, often at great monetary expense and for little or no return in terms of quality or length of life. At least two opportunities exist for making choices regarding care at the end of life in the U.S.: completing advance directives and choosing hospice care. This dissertation consists of three studies related to this topic. The first is a quantitative study about advance directives and attitude toward death. The advance directive completion rate among adults in the …

The Effect Of Art Therapy On Hospice And Palliative Caregivers, Carol E. Gress

Nursing Theses and Capstone Projects

A quazi-experimental, one-group, pretest/posttest study was conducted with a group of 25 hospice workers employed by a medium sized county hospice organization in the southeastern United States that was experiencing rapid personnel turn-over. Participants in the study included a doctor, a physician’s assistant, a nurse practitioner, a massage therapist, a grief counselor, a licensed practical nurse, a certified nursing assistant, two clergy, three administrative staff, three social workers, seven volunteers, eight registered nurses and one other. The purpose was to investigate whether attending four 1-hour art therapy sessions could help reduce stress and thereby Burnout. Stamm’s (2010) Professional Quality of …

Integrating Palliative Care Into The Care Of Neurocritically Ill Patients: A Report From The Improving Palliative Care In The Icu Project Advisory Board And The Center To Advance Palliative Care, J. A. Frontera, J. R. Curtis, J. E. Nelson, M. Campbell, M. Gabriel, A. C. Mosenthal, D. R. Lustbader, K. J. Brasel, S. P. Weiss, D. E. Weissman, +5 Additional Authors

Journal Articles

OBJECTIVES: To describe unique features of neurocritical illness that are relevant to provision of high-quality palliative care; to discuss key prognostic aids and their limitations for neurocritical illnesses; to review challenges and strategies for establishing realistic goals of care for patients in the neuro-ICU; and to describe elements of best practice concerning symptom management, limitation of life support, and organ donation for the neurocritically ill. DATA SOURCES: A search of PubMed and MEDLINE was conducted from inception through January 2015 for all English-language articles using the term "palliative care," "supportive care," "end-of-life care," "withdrawal of life-sustaining therapy," "limitation of life …

Intricate Conversations: Caring For Clients With Severe Mental Illness, John D. Chovan

Nursing Faculty Scholarship

This presentation describes the characteristics of persons living with severe mental illness who intersect with hospice, and palliative care, and their communication challenges.

Comparison Of Home Medication Adherence In Adults Age 65 And Older After Completion Of Standardized Discharge Medication Education Or Non-Standardized Discharge Medication Education, Jill Weller

Regis University Student Publications (comprehensive collection)

Executive Summary

Comparison of Home Medication Adherence in Adults Age 65 and Older After Completion of Standardized Discharge Medication Education or Non-Standardized Discharge Medication Education
Problem
The older patient (age 65 and older) is at higher risk of medication induced illness because of numerous co-morbid conditions treated with multiple medications, a standardized approach to medication education at hospital discharge can reduce adverse medication events for this at risk population (Esposito, 1995; Jack et al., 2009). The primary driving force for this project is the limited number of research studies published to date that include this specific age bracket and setting. …

Interdisciplinary Collaboration With Music Therapy During Routine Pediatric Dental Procedures, Austin S. Robinson

Theses and Dissertations--Music

The incorporation of integrative medicine into traditional treatment options has steadily increased during the past two decades. This has resulted in a change in the dynamics of interdisciplinary teams creating the need to better understand the roles and responsibilities of team members. The purpose of this study was to examine the perceptions of dental treatment team members regarding the role and responsibilities of music therapy during treatment.

A total of 10 participants were included in this study. Participants completed a pre-music therapy survey to establish prior knowledge, experience with, and perceptions of music therapy. Following an experiential intervention, participants completed …

Nursing Care At The End Of Life: What Every Clinician Should Know, Susan E. Lowey

Milne Open Textbooks

Nursing Care at the End of Life: What Every Clinician Should Know should be an essential component of basic educational preparation for the professional registered nurse student. Recent studies show that only one in four nurses feel confident in caring for dying patients and their families and less than 2% of overall content in nursing textbooks is related to end-of-life care, despite the tremendous growth in palliative and end-of-life care programs across the country. The purpose of this textbook is to provide an indepth look at death and dying in this country, including the vital role of the nurse in …

The Impact Of The Carer Support Needs Assessment Tool (Csnat) In Community Palliative Care Using A Stepped Wedge Cluster Trial, Samar Aoun, Gunn Grande, Denise Howting, Kathleen Deas, Chris Toye, Lakkhina Troeung, Kelli Stajduhar, Gail Ewing

Medical Papers and Journal Articles

Family caregiving towards the end-of-life entails considerable emotional, social, financial and physical costs for caregivers. Evidence suggests that good support can improve caregiver psychological outcomes. The primary aim of this study was to investigate the impact of using the carer support needs assessment tool (CSNAT), as an intervention to identify and address support needs in end of life home care, on family caregiver outcomes. A stepped wedge design was used to trial the CSNAT intervention in three bases of Silver Chain Hospice Care in Western Australia, 2012-14. The intervention consisted of at least two visits from nurses (2-3 weeks apart) …